Reposted with permission; originally posted in the 2015 spring edition of Cardiac Advantage

Traditional treatment for severe aortic stenosis – a narrowing of the valve that allows blood to flow from the heart to the body- has been to open the chest, remove the fault valve and replace it with a new one.

Many patients are too sick or too frail to tolerate open-heart surgery. “For a long time, we had little to offer patients with severe aortic stenosis if they were unable to undergo open heart surgery because of their age and/or the severity of their medical condition,” said cardiothoracic surgeon Andrew Pruitt, MD, at St. Joseph Mercy Ann Arbor. “Now there is new hope. In August 2012, we began performing an exciting new procedure, transcatheter aortic valve replacement (TAVR), that is holding great promise for patients who formerly had no options.”

Some people with aortic stenosis have no symptoms at all, but for most patients symptoms include: shortness of breath, fatigue, difficulty exercising or performing other strenuous tasks, chest pain, lightheadedness or fainting.

“In its earlier stages, aortic stenosis can be treated with medication, but in more advanced form traditional surgery, and now, TAVR are the only options.”

How does TAVR work? The surgeon makes an incision in the groin (transfermorally) or through a space in the rib cage (transpically) and threads a catheter into the blood vessel to reach the aortic valve. A balloon on the end of the catheter is inflated forcing open the stiff leaflets of the damaged aortic valve. This leaves room to replace the original catheter with a second one. The second catheter not only has a balloon on the end, but also a compressed replacement valve. The replacement valve is made of cow heart tissue that is sewn onto an expandable stainless steel stent. The new valve is placed on the center of the disease valve and then expanded into proper position with the aid of the balloon. Physicians can choose replacement valves to fit a wide range of patient sizes.

A key advantage is that the procedure is performed on a beating heart and the patient does not have to put on a cardiopulmonary bypass machine, so it is far less stressful for the body. The transfemoral approach usually requires about three hours to complete; the transapical about 30 minutes less.

Developed in 2000 by a French cardiologist, TAVR was approved for use in the United States in 2011, slightly ahead of schedule when clinical trials proved remarkably successful.

However, TAVR is still relatively new and not without risk. “Currently, this approach is limited to patients who must meet very specific criteria,” said Dr. Pruitt. “TAVR brings with it its own set of side effects and has as slightly higher rate of certain complications than traditional, open-heart surgery. The FDA has only approved its use for patients with severe, symptomatic aortic stenosis who are felt to be inoperable, or at very high risk for traditional surgery by two independent cardiac surgeons.”

In addition, potential candidates must undergo a series of test to determine if they meet the physical and medical parameters to accept the device safely. “We very carefully have to weigh risks versus benefits, and for those patients who cannot tolerate open-heart surgery, TAVR can be a life saver,” said Dr. Pruitt. “TAVR not only extends patients’ lives, it can significantly improve their quality of life.”

Cardiologists and cardiac surgeons at St. Joe underwent intensive training to learn this new surgical procedure. Based on the high volume of surgeries conducted here, the expertise of our physicians and staff, and the collaborative multidisciplinary heart team that evaluates all potential cases, patients who qualify for TAVR can feel confident in the skill level and experience of their heart team.

“The message to prospective patients and their referring physicians is this: Don’t give up hope. Even for the frailest patients with extremely advanced conditions, we can offer solutions and relief,” said Dr. Pruitt. “In cases where TAVR is an option, it literally can mean the difference between life and death.”

Please join us in welcoming Bhavani Sundram, MD to IHA Canton Family Medicine. Dr. Sundram is board-certified in family medicine and earned her medical degree from Wayne State University. Dr. Sundram is currently accepting new patients. Click here to learn more.

News Release
December 23, 2014
For Immediate Release
For more information, contact:
IHA
Amy Middleton
734-327-0877
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IHA Concludes 2014 by Welcoming Community Orthopedic Surgery, P.C. & Huron Valley Hand Surgery

ANN ARBOR, MI – (December 23, 2014) – IHA is pleased to announce its planned integration with Community Orthopedic Surgery, P.C & Huron Valley Hand Surgery, effective December 31, 2014. With offices in the Michigan Orthopedic Center on the St. Joseph Mercy Ann Arbor campus and in Brighton, the practice, comprised of Michael S. Fitzsimmons, MD; Fred M. Hankin, MD; John V. Hogikyan, MD; James L. Telfer, MD; and Mark R. Wilson, MD; has provided compassionate, patient focused care to patients across Southeast Michigan and beyond since 1984.

Dr. Walter “Mac” Whitehouse, Jr., IHA Surgery Department Chair commented that “these are not only nationally-recognized surgeons, but also outstanding individuals whom we are thrilled to welcome to the IHA family as IHA Community Orthopedic Surgery.”

“Ready and efficient exchange of clinical services between primary, specialty, and subspecialty providers is vital to delivering the high-quality, cost-effective care that patients need and expect today,” says Michael S. Fitzsimmons, MD, President of Community Orthopedic Surgery, P.C. & Huron Valley Hand Surgery. “Joining the IHA team enables us to achieve this by integrating our expansive range of orthopedic services with a high-quality physician group.”

Dr. Whitehouse also adds, “the surgeons provide a broad range of orthopedic capabilities along with sub-specialty expertise which all of us at IHA are now thrilled to have on the same team.”

  • Dr. Fitzsimmons has been active in general orthopedic surgery with particular emphasis on hand and microvascular reconstruction. This has included management of carpel tunnel syndrome, wrist pain, and complex replantation of free flap transfers. He has been involved with resident education at a number of programs. Dr. Fitzsimmons will serve as the Site Medical Director.
  • Dr. Hankin has interests in a variety of hand problems including congenital deformities, cerebral palsy, acute and late tendon injuries, rheumatologic conditions, infections, and hand problems related to quadriplegia.
  • Dr. Hogikyan has been an active provider of care to individuals with a variety of hand afflictions. He has wide ranging experience in management techniques for trauma, compressive neuropathies, nerve and tendon injuries, arthritis and fractures. Common surgeries performed include carpal tunnel release, tendon repair and arthritis surgery.
  • Dr. Telfer is active in general orthopedic surgery with an emphasis on sports medicine. His practice includes surgery of the knee and shoulder as well as primary joint replacement.
  • Dr. Wilson emphasizes hand and microvascular related conditions in his practice. Various types of non-surgical as well as surgical management are utilized in the care of conditions such as arthritis, trauma, nerve compression and wrist pain. Microvascular reconstruction is used for wound problems such as open fractures and osteomyelitis. He treats avascular necrosis of the hip joint at this center with vascularized fibula grafting.

According to Bill Fileti, IHA’s President & CEO, this integration with Community Orthopedic Surgery, P.C. & Huron Valley Hand Surgery represents another major development in a year full of successes and expansion. IHA celebrated its 20th anniversary in February 2014 and opened a new 44,000 square foot medical center at Domino’s Farms Office Park in May 2014. In June, IHA integrated with Michigan Heart and added 47 nationally recognized comprehensive cardiovascular physicians and practitioners. With an active and on-going physician recruitment program, IHA also strengthened its primary care and specialty capabilities with over 50 new physicians and practitioners.

“IHA continues to evolve into one of the largest and best multi-specialty group practices in Michigan,” notes Fileti. “With integrations, such as this upcoming partnership with Community Orthopedic Surgery, P.C. & Huron Valley Hand Surgery, IHA continues our commitment to expanding our capabilities in order to give our patients outstanding quality, easy access and cost effective care.”

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About IHA
IHA is one of the best and largest multi-specialty groups in Michigan. IHA employs more than 1,500 staff members, which includes 425 providers consisting of: physicians, nurse practitioners, physician assistants and midwives across 55 practices in Southeast Michigan. IHA provides high quality medical care and excellent service to more than 355,000 active patients. Recognized as one of Michigan’s top performing medical groups, IHA also ranks in the top quartile for patient satisfaction nationally. Offering extended office hours, Urgent Care, and access to clinical research studies, IHA demonstrates that it cares by bringing safe, high quality, comprehensive and affordable care to its patients. For more information about IHA, visit www.ihacares.com.

About Community Orthopedic Surgery, P.C. & Huron Valley Hand Surgery
Community Orthopedics has been providing high quality, nationally-recognized orthopedic care to patients in Southeast Michigan for over 30 years. With five exceptional surgeons - four specializing in hand and microvascular surgery and one in general orthopedics with an emphasis on sports medicine – Community Orthopedics has consistently delivered efficient, compassionate, patient focused care with an emphasis on teamwork. Community Orthopedics has conveniently located clinics in the Michigan Orthopedic Center on the St. Joseph Mercy campus in Ann Arbor and in the St. Joseph Mercy Brighton building on Grand River in Brighton.